I have found one of the most underrated skills in primary care isn’t diagnosing or prescribing — it’s agenda setting.
As a new grad PA, it’s easy to walk into a visit with good intentions and walk out 45 minutes later wondering how you ended up discussing knee pain, sleep issues, a rash, reflux, and three refills… and didn’t ever ask about colonoscopy or let them know you want to order surveillance bloodwork for their diabetes.
Learning how to set the agenda early (and kindly) will save you time, protect your energy, and lead to better visits for both you and your patients.
Here’s the general approach I use.
Step 1: Pre-chart with intention
If you have the time or EMR structure that allows you to pre-chart the day prior – DO IT. If not, or if you have high no-show rates like I do in a rural clinic, it may pay off more to just quickly chart review before you enter the room and after the patient checks in. So take a few minutes to orient yourself to the patient you are about to see, I do this once I’ve seen they’ve checked in while the MA/nurse is rooming them.
I focus on three things:
1. Health maintenance
- Routine screenings (colon, breast, cervical, lung)
- Vaccines
- Labs
- Chronic disease follow-ups (A1C, BP, etc)
These are the non-negotiables of primary care and easy to forget once the visit goes sideways.
2. Acute concerns already reported
Review what the MA or nurse documented, or if there was a recent patient message or telephone call reporting a concern. Even a quick glance helps you mentally prepare:
- What systems are involved?
- What ROS questions do I need?
- What physical exam will I likely perform?
- What labs/diagnostics will I likely order?
If they have a multitude of concerns reported, I may jot down a couple bullets so I don’t forget once I’m in the room. (I did this on EVERY visit when I first started out). I also pend any orders or referrals I’m certain about – it is much quicker to delete them after if you and the patient decide against them.
3. Mental prioritization
Ask yourself: What absolutely needs to be addressed today?
This helps later when you need to redirect the visit and helps you start with the issues that are most concerning.
Step 2: Start the visit with connection (but keep it brief)
Once you’re in the room:
- Greet the patient
- Make eye contact
- Use their name
- One sentence of rapport goes a long way (I sometimes use the sticky note feature in my EMR to leave a note for my future self about the patient’s job, family, pets, travel plans, etc)
This doesn’t need to be a long conversation — just enough to establish trust before you guide the visit. Brand new patient? I comment on an article of their clothing, comment on the weather, inquire about recent holidays, etc.
Step 3: Set the agenda out loud
This is the key step — and the one many new grads skip.
I usually say something like:
“Today I’d like to start by reviewing your routine health maintenance and any screenings or labs you’re due for, and then we’ll make sure we address the concerns (X, Y, Z) you mentioned.”
This does a few important things:
- Signals structure
- Sets expectations
- Establishes you as the guide of the visit
- Makes it clear there’s a plan
Most patients appreciate knowing what’s coming, and that you listened to what concerns the patient already reported.
Step 4: Tackle health maintenance first
Why this matters:
- These are the “must-do” items in primary care
- They’re often forgotten if saved for last
- They’re harder to postpone than many acute issues
By addressing health maintenance early:
- You ensure quality metrics are met (unfortunately this is a huge focus in many healthcare organizations)
- You protect yourself if time runs out
- You keep the visit anchored
Once this is done, you feel more aware of what time is actually remaining for their acute concerns.
Step 5: Address acute concerns — with boundaries
After health maintenance, transition to their concerns.
If there are multiple issues, this is where agenda setting really pays off. You can say:
“We now have time to address one or two concerns thoroughly today. Which is the most important for you to focus on?”
This empowers the patient and protects the visit.
If something comes up that clearly needs more time, it becomes much easier to say:
“I want to give that the attention it deserves. Since we’ve taken care of your healthcare maintenance and [insert chronic condition here] today, let’s schedule a follow-up visit in [X] amount of time to dive deeper into that so we don’t miss anything.”
Because you’ve already completed the “must-do” items, postponing feels appropriate — not dismissive.
Why this approach works (especially in primary care)
- It reduces visit chaos
- It helps you manage time without feeling rushed
- It builds patient trust through transparency
- It helps in protecting you from burnout
Primary care will always be overwhelming at times — but it doesn’t have to feel out of control at EVERY visit.
Agenda setting is a skill. Like anything else in medicine, it gets easier with practice.
Final thoughts
As a new grad PA, you don’t need to do everything perfectly — but having a repeatable visit structure will change your day-to-day experience in clinic.
Pre-chart with intention.
Set the agenda early.
Handle the must-do items first.
Your patients will feel more cared for — and you’ll leave work feeling more in control.
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Let me know if you have any questions about this skill! I am happy to chat one on one with those interested in learning more!
Stethoscope And Suitcase 
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